HomeMy WebLinkAbout19-21800 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21800
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21800 Address: 6585 SIMONS RD
Permit Type: MISC ZEPHYRHILLS, FL.
Class of Work: RIGHT-OF-WAY Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 04-26-21-0000-39900-0010
Improv. Cost: OWNER INFORMATION
Date Issued: gAA Name: CITY OF ZEPYRHILLS
Total Fees: � Address: 5335 8TH ST
Amount Paid: ZEPHYRHILLS, FL 33542-4312
Date Paid: Phone:
Work Desc: MIS SEE STREET DESCRIPTION SIMONS RD- FEE WAIVED ************
CONTRACTORS APPLICATION FEES
JO DELOTTO & SONS INC
Ins ections Required
FOOTER 2ND ROUGH PLUMB MI C INSULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications Must Accompany Application. All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTPACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
City of Zephyrhills
Water and Sewer Impact Fee Calculation
Land Use Type:
Recreational or Sports Facility
(A) Per Person without Showers
No. of Persons
Impact Fees For Type A
Within City Limits Outside City Limits
Water Facilities Capacity Fee $ - $
Wastewater Facilities Capacity Fee $ - $ -
TOTAL $
(B) Per Person with Showers
No. of Persons f 180
Impact Fees For Type B
Within City Limits Outside City Limits
Water Facilities Capacity Fee $ 15n02-4- 7g, $ 18,780.99
Wastewater Facilities Capacity Fee $ -=-31090:9M $ 38,863.64
TOTAL 57,644.63
CITY OF ZEPHYRHILLS—BUILDING DEPARTMENT
'RIGHT-OF-WAY USE PERMIT
DATE: August stir,2019 PERMIT#-aS81-'2A
No construction under ground or above ground of any facility shall be accomplished on any City Rights of Way without written approval from the City Building
Department. Any application for approval of construction operations on any City owned Rights of Way shall fumish a detailed drawing showing the complete
scope of the proposed work in triplicate to the office of the Building Official for approval prior to the commencement of any work. A copy of this parmit Is to be
kept readily available at the site of the work at all times.
PARCEL ID#: 04-26-21-0000-39900-0010 CITY ROAD Simons Road
LOCATION(Legal Description):
6505 Simons Road,Zpphyr1hillp,FL 33541
Permission is hereby granted to Craig D.Lamberson,President Of 3.0.DeLotto&Sons,Inc.
For the construction and maintenance of
Ingress and egress drives,including curbing and pavement
Subject to the following conditions:
1. The construction and maintenance of such utility shall not interfere with the property and rights of a prior occupant.
2. All work shall be done in keeping with the standards of the City Streets Department and under the supervision of the City Building Official,who
will be notified at least one day prior to commencement of construction.
3. A materials and equipment shall be subject to Inspection by the City Building Official.
4. During construction all safety regulations of the Department of Transportation shall be observed and the City shall be relieved of all responsibility
from damage of any nature arising from this permit. Subject to the same terms and conditions,the permit holder may take such safety measures,
including placing and display of caution signs,as It may deem necessary In conduct of construction and maintenance work hereunder. It is the
responsibility of the permittee to 777?
5. All private and all City property shall he restored to its original condition as far as practical In the opinion of the City Building Official.
6. AD underground crossing installations shall be laid at such depth as may be specified by the City Building Official,
7. The sketch covering the details of this Installation shall be made a part of this permit. This permit Is granted with the understanding that the
applicant has notified all other utility users in the area covered by the permit and takes full responsibility for any damage incurred by prior
installations as a result of his operations in order that they may safe guard their interests.
8. It is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to this
Permit shall not operate to create of to vest any property right In said holder.
9. Whenever the City decides to further exploit the City Rights of Way, any or all said poles, wires, pipes, cables, or other facilities and
appurtenances authorized hereunder,shall be immediately removed from said Rights of Way,or reset or relocated thereon es required by the
City Building Official at the expense of the holder of this penrift.
10. The holder shall save and keep the City harmless from any and all damages,claims,or injuries that may occur by reason of the construction.
maintenance,and operation of sold facility.
11. The holder shall complete the requested work within 365 days or this permit shall become null and void. In the event the work requested is
not completed upon the expiration date of this permit.the City shall have the right to complete such work and to charge the holder of the permit
for aft costs incurred in completed said work.
12. The holder shall post a cash or surety bond with the City Manager in the sum of$_NLA_dollars to guarantee performance of the
obligations herein,and to guarantee maintenance of the right-of-way described herein for a period of one(1)year following completion of the
requested installation. In the event a surety bond is posted,the surety bond shall be made payable to the City and shall obligate the surety to
hold The City harmless in the event the holder of this permit should fall to meet any of its obligations hereunder. The bond shall also indemnify
the City for all court costs and reasonable attorneys fees in the event legal action Is required to called on said bond.
SUBMITTED BY:
(PERMITTEE) 3.0.DeLoJo&Sons.Xf%1
Signature&Title._ President
Address 924 E.Busch Boulevard,Tampa,FL 33612-8598
APPROVED BY:
CITY OF ZEPHYRHILLS
Utilities Supervisor Date
Public Works 1-1— Date-- 1-PA
t
—q
Building Dept K' Date
City Manager Data
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813-814-1816
From: Gina Nappi [mailto:gnappi@delotto.com]
Sent:Tuesday, December 03, 2019 12:14 PM
To: Tim Bombalicki; Bill Hunsberger; Matt Bonnell
Cc: Jodi Tikkanen; Accounting; Lauren Fuller
Subject: FW: SVBTC- Building Permit Info
PLEASE SEE JACKIE'S REQUESTS BELOW FOR EACH OF YOUR COMPANIES, PLEASE ADVISE WHEN SUBMITTED!
Thank you! Q
Gina M Nappi
Project Administrator
DeLotto
Established 1946
J. 0. DeLotto &Sons, Inc.
General Contractor and Construction Manager
924 E. Busch Boulevard e Tampa • FL 33612-8598
(813) 935-2191 Office • (813) 935-2456 Fax
www.delotto.com
CONFIDENTIALITY NOTE: The information contained in this communication may be confidential, is intended only for the
use of the recipient named above, and may be legally privileged. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution, or copying of this communication, or any of its
contents, is strictly prohibited. If you have received this communication in error, please re-send this communication to the
sender and delete the original message and any copy of it from your computer system. Thank you.
From:Jacqueline Boges<iboges@ci.zephyrhills.fl.us>
Sent:Tuesday, December 03, 2019 12:06 PM
To:Gina Nappi<gnappi@delotto.com>
Cc:Craig Lamberson<Clamberson@delotto.com>;Gary Davis<gdavis@delotto.com>; Kyle Lewis<klewis@delotto.com>
Subject: RE:SVBTC-Building Permit Info
Okay now we are getting somewhere.
Still waiting on registrations they are coming but slowly...
`N,eed total=air business-taX rL-ceiptantLstate-license-
Hunsberger-plumbing-n-eefd--business-tax--r"eceipt-anA`st�e license
F�e ec r-f�T is need=business-tax-receipt:-
2
Jacqueline Boges
From: Jacqueline Boges
Sent: Tuesday, December 3, 2019 12:33 PM
To: 'Gina Nappi'
Subject: RE: SVBTC - Building Permit Info
Not this one need business tax receipt and it will say across top of license.
From:Gina Nappi<gnappi@delotto.com>
Sent:Tuesday, December 3, 2019 12:20 PM
To:Jacqueline Boges<jboges@ci.zephyrhills.fl.us>
Subject: FW:SVBTC-Building Permit Info
EXTERNAL EMAIL
One down,two to go Lady! @
Gina M Nappi
Project Administrator
DeLotto
Established 1946
J. O. DeLotto &Sons, Inc.
General Contractor and Construction Manager
924 E. Busch Boulevard • Tampa • FL 33612-8598
(813) 935-2191 Office a (813) 935-2456 Fax
www.delotto.com
CONFIDENTIALITY NOTE: The information contained in this communication may be confidential, is intended only for the
use of the recipient named above, and may be legally privileged. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution, or copying of this communication, or any of its
contents, is strictly prohibited. If you have received this communication in error, please re-send this communication to the
sender and delete the original message and any copy of it from your computer system. Thank you.
From:Accounting<Accounting@FalconElectriclnc.com>
Sent:Tuesday, December 03, 2019 12:17 PM
To:Gina Nappi<gnappi@delotto.com>
Cc: Nancy<nancv@ Falcon Electriclnc.com>;Tim Bombalicki<tim@Fa Icon Electriclnc.com>
Subject: RE:SVBTC-Building Permit Info
Gina,
This is all of our stuff including our tax receipt you requested.
That* you
Thank you
IN-
Jackie Boges
813-780-0020 ext3513
"A rule I have had for years is:to treat the Lord Jesus Christ as a personal friend. His is not a creed,a mere doctrine, but it is He
Himself we have."Dwight L. Moody
Florida has a very broad public records law. Electronic communications regarding most City
of Zephyrhills business are public records and available upon request. Your e-mail
communications may therefore be subject to public disclosure. If you received this message in
error, please do not read, forward, copy, etc. and delete immediately.
From:Gina Nappi<gnappi@delotto.com>
Sent:Tuesday, December 3, 2019 11:29 AM
To:Jacqueline Boges<]boges@ci.zephyrhills.fl.us>
Cc:Craig Lamberson <Clamberson@delotto.com>;Gary Davis<gdavis@delotto.com>; Kyle Lewis<klewis@delotto.com>
Subject:SVBTC- Building Permit Info
EXTERNAL EMAIL
Good morning Ms.Jackie,
Attached are the signed copies for the MEP portion of the Building Permit Application—
Hopefully you will have everything you need to help us get the permit processed? If not, please let me know what else I
need to obtain for you?
Also, Craig would like to know if he needs to be the one picking up the permit?Or can we send our Superintendent Gary
Davis again?
Thank you,
Gina M Nappi
Project Administrator
DeLotto
Established 1946
J. 0. DeLotto &Sons, Inc.
General Contractor and Construction Manager
924 E. Busch Boulevard •Tampa • FL 33612-8598
(813) 935-2191 Office • (813) 935-2456 Fax
www.delotto.com
CONFIDENTIALITY NOTE: The information contained in this communication may be confidential, is intended only for the
use of the recipient named above, and may be legally privileged. If the reader of this message is not the intended
3
CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21501
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21501 Address: 6585 SIMONS RD
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: SITE WORK Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: IParcel Number: 04-26-21-0000-39900-0010
Improv. Cost: 731,535.00 .OWNER INFORMATION
Date Issued: 7/16/2019 X7 Name: CITY OF ZEPYRHILLS
Total Fees: 3,695.00 (,z eo�4 Address: 5335 8TH ST
Amount Paid: 3,695.00 `ice ZEPHYRHILLS, FL 33542-4312
Date Paid: 7/16/2019 Phone:
Work Desc: SITE WORK ONLY**** TENNIS CENTER FEE WAIVED
CONTRACTORS APPLICATION FEES
JO DELOTTO & SONS INC BUILDING FEE 3,695.00
Ins ections.Required
FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
INSTR#2019120219 OR BK 9940 PG 1963 Page 1 of 1
07/17/2019 11:19 AM Rcpt;2072925 Rec:10.00 DS:0.00 IT:0.00
Nikki Alvarez5owles,Esq., Pasco County Clerk&Comptroller, ad Interim
Parmli No. 1115101 Pareel10 No 014 LV` y—v Qa�0
NOTICE OF COMMENCEMENT
State of Florida county of Pasco
THE UNDERSIGNED hereby glvas notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following Information 13 provided In this Notice of Commencement
1. Description of Property: Parcel Identification No,
Street Address: 6585 Smons Road,ZephvrhilL%FL 33541
2. General Description of Improvement 7,350sf Oubhouse,23 Sports Courts,Parking,and Ancillary Site and Underground Utility Work
3, Owner Information or Lessee Information If the Lessee contracted for the Improvement:
City,of Zephyihllls
Name
5335 Sth Street Zephvrhflls FL
Address City state
Interest in Property: Fee Simple
Name of Fee Simple Titleholder.
Of different from Owner listed above)
4. contractor CRY
or. J,0. rtc.Detotto&Sons.I State
Name
924 E.Busch Blvd. Tampa FL
Address City State
Cordmctor'a Telephone No.: (8131935.2191
S. Surety: Llberty Mutual Insurdwe Company
Namo
175 Berkley Street Bacon MA
Address CIry Stale
Amount of Bond: s 4,724,346.00 Telephone No.:
S. Lender. NIA
Name
Address City State
lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be nerved as provided by
Section 713A3(111a)(7),Florida Statutes:
Name
Address City Slate
Telephone Number of Designated Person:
a. In addition to himself,the owner designates of_
to receive a copy of the Llartoes Notice as provided in Sedan 713.13(1)(b),Fiodda Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration dale of Notice of Commencement(the expiration date may not be before the completion of construction and Mel payment to the
contractor,but will be one year from the data of recording unless a different dale Is rped ed):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1. SECTION 713.13, FLORIDA STATUTES AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMEa MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT,
of de kneowledof end r fief.declare
�t I have read the foregoing notice of commencement and that the fads stated therein ere true to the best
STATE OF FLORIDA
COUNTY OF PASCO V •'[p$ r.
CITY OF ZEPHYRHILLS Signature of Owner or Lessee,orOvnees or Lessee's Authorized
OfficedDiredodPadnedMenagar
Signatory's T'd face
The foregoing Instrument was admawiedged before m_ie this '�e'y of t.1 2D/_?bY l 2.,
Ityp of authadty,e.g..officer,trustee.attorney In fact for
(name of party on behalf of wham Instrument w4s executed).
Personally Known$4fLed Ida4milon❑ Notary Signature
T o d ti P ew
Name(PdM) n'1'�• l '1_//7?Jh�
'ultY AMON Iguolum 459J41 popup8
ZZOZ It 15nv sajlda3 vox)6W ;►+o`•
611ZQDL 7'J 0 UOISSIWW03 �
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NYWITH 1 Itl01
wpdoln& /nopeoeommencemanlpeOS3049
813-780-0020 City of Zephyrhills Permit Application Fax-813-7B0-0021
Building Department
Date Received
rrrrrrrn 11..............rrrrTTrrrrrrrrrr Phone Contact for Permitting...........
Owner's Name 0 Owner Phone Number
E Iq WL
Owner's Address15 L" Owner Phone Number
Owner Phone Number
JOB ADDRESS LOT#
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR R ADD/ALT SIGN DEMOLISH
e INSTALL REPAIR
PROPOSED USE Q SFR E:] COMM OTHER
TYPE OF CONSTRUCTION BLOCK Q FRAME 0 STEEL
cr
DESCRIPTION OF WORK
BUILDING SIZE SCI FOOTAGE HEIGHT
=BUILDING $ VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL 1$ AMP SERVICE DUKE ENERGY W.R.E.C.
=PLUMBING 1$
=MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION Ap C ' a �
=GAS ROOFING 0 SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA ]YES NO
I
BUILDER COMPANY
SIGNATURE FEE CURREN -T REGISTERED LY/ N Y/N
Address License
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address I License#
PLUMBER COMPANY L_
SIGNATURE REGISTERED Y/ N FEE CURREN L_y LN J
Address I License# r
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address i License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN LILN
Address License#
HHHHH III H It HHHHH!it HIM HHHHH HHHHHH HHHHH HiHH!III!!!!+
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new projects,All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
...........
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (AIC upgrades over$7500)
Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired 'a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified lin Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and'Resource Recovery Fees must be paid prior to
receiving a `certificate of occupancy" or final power release. If the.project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is$2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction,Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"W unless expressly permitted.
- If the fill material is to" be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICEOF-COMMENCEMENT.
FLORIDA JURAT(F.S.117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed and sworn to(or affirmed)before me this
by by
Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
as identification. as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped